德国明斯特大学医院Melanie Meersch团队研究了术中移交麻醉护理对患者死亡率、再入院率或术后并发症的影响。该研究于2022年6月4日发表在《美国医学会杂志》上。

术中移交麻醉护理很常见。移交可能通过减少医生疲劳来改善护理，但也存在丢失关键信息的固有风险。大型观察分析报告了麻醉护理的移交与不良事件之间的关联，包括较高的死亡率。

为了探讨麻醉护理交接对术后发病率和死亡率的影响，研究组在德国12个中心进行了一项平行组随机临床试验，患者于2019年6月至2021年6月登记，最终随访至2021年7月31日。符合条件的参与者身体状况为美国麻醉师协会3或4级，并计划接受预计持续至少2小时的大型住院手术。

共有1817名参与者被随机分为两组，908名接受移交至另一位临床医生进行麻醉护理，909名不移交麻醉护理。参与机构均未使用标准化的移交协议。主要结局是30天的全因死亡、再次住院或严重的术后并发症。共有19项次要结局，包括主要综合指标的组成部分，以及重症监护病房和住院时间。

1817名随机患者的平均年龄为66岁，997名为男性（56%），1717名（97%）美国麻醉师协会身体状况为3级，1772名（98%）完成了试验。移交组总麻醉时间的中位数为267分钟，从开始麻醉到首次移交的中位数为144分钟。移交组891名患者中有268名（30%）出现了综合主要结局，而未移交组881名患者中有284名（33%），优势比（OR）为0.89，差异不显著。

移交组889例患者中有19例（2.1%）在30天内发生全因死亡，未移交组873例患者中有30例（3.4%），OR为0.61；移交组888例患者中有115例（13%）再次入院，未移交组872人中有136例（16%），OR为0.80；移交组890例患者中有195例（22%）出现严重的术后并发症，未移交组874例中有189例（22%），OR为1.02，组间差异均不显著。19个预先指定的次要终点亦无显著差异。

研究结果表明，在接受延长手术的成年人中，随机接受麻醉护理移交的患者与未接受移交的患者相比，在30天内死亡率、再入院率或严重术后并发症的综合主要结局方面没有显著差异。

附：英文原文

Title: Effect of Intraoperative Handovers of Anesthesia Care on Mortality, Readmission, or Postoperative Complications Among Adults: The HandiCAP Randomized Clinical Trial

Author: Melanie Meersch, Raphael Weiss, Mira Küllmar, Lars Bergmann, Astrid Thompson, Leonore Griep, Desiree Kusmierz, Annika Buchholz, Alexander Wolf, Hartmuth Nowak, Tim Rahmel, Michael Adamzik, Jan Gerrit Haaker, Carina Goettker, Matthias Gruendel, Andre Hemping-Bovenkerk, Ulrich Goebel, Julius Braumann, Irawan Wisudanto, Manuel Wenk, Darius Flores-Bergmann, Andreas Bhmer, Sebastian Cleophas, Andreas Hohn, Anne Houben, Richard K. Ellerkmann, Jan Larmann, Julia Sander, Markus A. Weigand, Nicolas Eick, Sebastian Ziemann, Eike Bormann, Joachim Ger, Daniel I. Sessler, Carola Wempe, Christina Massoth, Alexander Zarbock

Issue&Volume: 2022-06-04

Abstract:

Importance  Intraoperative handovers of anesthesia care are common. Handovers might improve care by reducing physician fatigue, but there is also an inherent risk of losing critical information. Large observational analyses report associations between handover of anesthesia care and adverse events, including higher mortality.

Objective  To determine the effect of handovers of anesthesia care on postoperative morbidity and mortality.

Design, Setting, and Participants  This was a parallel-group, randomized clinical trial conducted in 12 German centers with patients enrolled between June 2019 and June 2021 (final follow-up, July 31, 2021). Eligible participants had an American Society of Anesthesiologists physical status 3 or 4 and were scheduled for major inpatient surgery expected to last at least 2 hours.

Interventions  A total of 1817 participants were randomized to receive either a complete handover to receive anesthesia care by another clinician (n=908) or no handover of anesthesia care (n=909). None of the participating institutions used a standardized handover protocol.

Main Outcomes and Measures  The primary outcome was a 30-day composite of all-cause mortality, hospital readmission, or serious postoperative complications. There were 19 secondary outcomes, including the components of the primary composite, along with intensive care unit and hospital lengths of stay.

Results  Among 1817 randomized patients, 1772 (98%; mean age, 66 [SD, 12] years; 997 men [56%]; and 1717 [97%] with an American Society of Anesthesiologists physical status of 3) completed the trial. The median total duration of anesthesia was 267 minutes (IQR, 206-351 minutes), and the median time from start of anesthesia to first handover was 144 minutes in the handover group (IQR, 105-213 minutes). The composite primary outcome occurred in 268 of 891 patients (30%) in the handover group and in 284 of 881 (33%) in the no handover group (absolute risk difference [RD], 2.5%; 95% CI, 6.8% to 1.9%; odds ratio [OR], 0.89; 95% CI, 0.72 to 1.10; P=.27). Nineteen of 889 patients (2.1%) in the handover group and 30 of 873 (3.4%) in the no handover group experienced all-cause 30-day mortality (absolute RD, 1.3%; 95% CI, 2.8% to 0.2%; OR, 0.61; 95% CI, 0.34 to 1.10; P=.11); 115 of 888 (13%) vs 136 of 872 (16%) were readmitted to the hospital (absolute RD, 2.7%; 95% CI, 5.9% to 0.6%; OR, 0.80; 95% CI, 0.61 to 1.05; P=.12); and 195 of 890 (22%) vs 189 of 874 (22%) experienced serious postoperative complications (absolute RD, 0.3%; 95% CI, 3.6% to 4.1%; odds ratio, 1.02; 95% CI, 0.81 to 1.28; P=.91). None of the 19 prespecified secondary end points differed significantly.

Conclusions and Relevance  Among adults undergoing extended surgical procedures, there was no significant difference between the patients randomized to receive handover of anesthesia care from one clinician to another, compared with the no handover group, in the composite primary outcome of mortality, readmission, or serious postoperative complications within 30 days.

DOI: 10.1001/jama.2022.9451

Source: https://jamanetwork.com/journals/jama/fullarticle/2793288